Public Hospital Services Research Articles

Impact of a health services innovation university program in a major public hospital and health service: a mixed methods evaluation

BackgroundWhile health services and their clinicians might seek to be innovative, finite budgets, increased demands on health services, and ineffective implementation strategies create challenges to sustaining innovation. These challenges can be addressed by building staff capacity to design cost-effective, evidence-based innovations, and selecting appropriate implementation strategies. A bespoke university award qualification and associated program of activities was developed to build the capacity of staff at Australia’s largest health service to implement and evaluate evidence-based practice (EBP): a Graduate Certificate in Health Science majoring in Health Services Innovation. The aim of this study was to establish the health service’s pre-program capacity to implement EBP and to identify preliminary changes in capacity that have occurred as a result of the Health Services Innovation program.MethodsA mixed methods design underpinned by the Consolidated Framework for Implementation Research informed the research design, data collection, and analysis. Data about EBP implementation capacity aligned to the framework constructs were sought through qualitative interviews of university and health service executives, focus groups with students, and a quantitative survey of managers and students. The outcomes measured were knowledge of, attitudes towards, and use of EBP within the health service, as well as changes to practice which students identified had resulted from their participation in the program.ResultsThe Health Services Innovation program has contributed to short-term changes in health service capacity to implement EBP. Participating students have not only increased their individual skills and knowledge, but also changed their EPB culture and practice which has ignited and sustained health service innovations and improvements in the first 18 months of the program. Capacity changes observed across wider sections of the organization include an increase in connections and networks, use of a shared language, and use of robust implementation science methods such as stakeholder analyses.ConclusionThis is a unique study that assessed data from all stakeholders: university and health service executives, students, and their managers. By assembling multiple perspectives, we identified that developing the social capital of the organization through delivering a full suite of capacity-building initiatives was critical to the preliminary success of the program.

Improving Quality in Public Health Service: An Integrated Approach to the Kano Model and the Balanced Scorecard

ABSTRACT There is growing interest in evaluating the quality of services provided. This has allowed government program and policy makers to identify bottlenecks and highlight requirements that lead to the optimization of public resources. Furthermore, the supply of public health services tends to be precarious in developing countries due to increased demand and diminished resources. Thus, this paper proposes an integrated approach to the Kano Model and the Balanced Scorecard perspectives for improving public hospital services. The investigation was carried out in a Brazilian public hospital. The hospital is known as a regional reference center in several medical specialties and one of the pioneers in total quality programs in public hospitals in the country. This study is original because it developed a new approach that integrates the BSC and the Kano Model for the context of health services. The association between these methodologies is useful for strategic planning and a better understanding by managers of the aspects that most impact patient satisfaction in the public hospital. This approach allows hospital public managers to assess the program’s internal efforts to combat neglected diseases and improve patient adherence indicators for treatment. The assessments can also be used as monitoring tools and parameters so that decision makers can make improvements in public health actions.

Determinants of induced abortion among women received maternal health care services in public hospitals of Arba Minch and Wolayita Sodo town, southern Ethiopia: unmatched case\u2013control study

BackgroundAbout 210 million women become pregnant per year, with one out of every ten pregnancies terminating unsafely worldwide. In developing countries, unsafe induced abortion is a leading cause of maternal mortality and morbidity. In addition, the burden of public health is also greatest in developing regions. In Ethiopia, abortion was responsible for 8.6% of maternal deaths. Despite the problem's significance, little is known about the factors that lead to women terminating their pregnancies. Therefore, this study aims to identify the factors associated with having induced abortion in public hospitals of Arba Minch and Wolayita Sodo town, Southern Ethiopia.MethodsAn institutional-based unmatched case–control study was conducted among 413 women from 15th April to 15th June 2021 in selected public hospitals of Arba Minch and Wolayita Sodo town, Southern Ethiopia. Cases were women who received induced abortion care services or who received post-abortion care services after being presented to the selected public hospital with an attempt of induced abortion whereas controls were women who came for maternal health care (antenatal or postnatal care) services in selected public hospitals and never had history of induced abortion. The data were collected by pretested and structured questionnaires with face-to-face interviews via Kobo Collect v3.1 mobile tools and analyzed by STATA version14. Logistic regression model was used to identify factors associated with induced abortion. In this study P-value less than 0.05 with 95% CI was declared a result as statistically significant.ResultsIn this study, 103 cases and 309 controls were participated. Urban residence (AOR = 2.33, 95%CI:1.26, 4.32), encountered first sex at age of 20–24 years (AOR = 0.51, 95%CI:0.27,0.97), multiple sexual partner (AOR = 5.47, 95%CI: 2.98,10.03), women who had one child (AOR = 0.32, 95%CI: 0.10, 0.99), and good knowledge of contraceptives (AOR = 0.12, 95%CI: 0.03, 0.46) were identified as determinants of induced abortion.ConclusionsInterventions focusing on those identified factors could probably reduce the burden and consequences of induced abortion. Sexual and reproductive health education and family planning programs would target urban dwellers, women who start sexual intercourse between the ages of 15 and 19, women with more than one sexual partner, women with a desire to limit childbearing, and women with poor contraceptive knowledge in order to reduce induced abortion.

Accuracy of the Simplified HOSPITAL Score to Predict Nonelective Readmission in a Brazilian Tertiary Care Public Teaching Hospital.

Predictive models to identify patients at high risk of readmission have gained the attention of health care teams, which have focused the strategies to reduce unnecessary readmissions on the "at-risk" patients. The HOSPITAL score includes 7 predictor variables with a C-statistic of 0.70 or more when applied to international datasets. Its simplified version retains a C-statistic at around the same level, but only incipient external validation has been attempted to date. The primary objective of this study was to evaluate the prognostic accuracy of the simplified HOSPITAL score to predict nonelective hospital readmissions in a tertiary care public teaching hospital in Brazil. We used a retrospective cohort that included all patients discharged from the internal medicine service of a Brazilian tertiary care public teaching hospital in 2018. We excluded patients who died before index discharge, were transferred to another institution, left against medical advice, or were readmitted electively. We calculated the simplified HOSPITAL score for each admission, and admissions were divided into low (0-4 points) or high risk (≥ 5 points) of nonelective 30-day readmission. We estimated accuracy, area under the receiver operating characteristic curve (AUC), and observed/expected (O/E) readmission ratio; the latter using the mid-P exact test with Miettinen's modification at a 95% confidence interval (CI). A P value < .05 was considered significant. A total of 4472 hospital discharges were analyzed during the study period after application of the exclusion criteria. The nonelective 30-day readmission rate was 14.0% (n = 625). Of all patients discharged, 3173 (71.0%) were considered to be at low risk and 1299 (29.0%) at high risk of readmission according to the simplified HOSPITAL score. The AUC was 0.68 (95% CI: 0.66-0.71; P < .001). The nonelective 30-day readmission rate was 9.2% in the low-risk group (expected: 9.2%; O/E: 1.0 [95% CI: 0.89-1.12]) and 25.7% in the high-risk group (expected: 27.2%; O/E: 0.95 [95% CI: 0.85-1.05]) ( P < .001). At a cut-off of 5 points, the score had a sensitivity of 53.4%, specificity of 74.9%, positive predictive value of 25.7%, and negative predictive value (NPV) of 90.8%. The parameters of the score were almost identical to the original study, with better applicability to exclude low-risk patients given its high NPV. Additional adjustments are still needed for better applicability in daily clinical practice.

Assessment of Knowledge and Utilization of Maternal and Neonatal Health services in Public Hospitals of district Dera Ghazi Khan

Background: Poor utilization of healthcare services during pregnancy, child delivery, and postpartum is a significant cause of maternal and child mortality. Antenatal and postnatal care is the most effective intervention for maternal and infant mortality and morbidity, especially in areas where women's general health is poor. Objectives: This study was conducted to find out the mother's knowledge about maternal and neonatal services to determine the utilization of maternal and neonatal services in public hospitals of District Dera Ghazi Khan. Methodology: A cross-sectional study was conducted in a public hospital in Dera Ghazi Khan. A structured questionnaire was used to collect data about the knowledge and utilization of antenatal care services among pregnant women. Results:The findings of the present study showed that 58.4% of respondents have good knowledge of antenatal care, while 41.6% showed poor ability. Among total respondents, 46.32% showed positive utilization of ANC services, while 53.68% showed poor utilization. A statistically significant difference has been found between respondents' income and ANC knowledge (p=0.02). A statistically significant difference was found between respondents' education and ANC knowledge (p=0.01). Among respondents who have their first pregnancy, 45(72.58%) have good ANC service utilization (p=0.002). Among respondents who were satisfied with the ANC services, 81(89.01%) were utilizing early ANC, whereas 10 (10.98%) were utilizing late ANC services (p=0.01). Conclusion: Overall findings of this research have shown that respondents' knowledge and utilization of ANC were not satisfactory. For more improvement, there is a need to educate women and provide them with adequate facilities to utilize maternal and neonatal care services.

Accuracy of ultrasound in the estimation of customised birth weight in a public hospital service.

Studies have shown that ultrasound estimated foetal weight (EFW) in small for gestational age (SGA) babies tends to be less-accurate when compared to appropriate (AGA) and large (LGA) for gestational age babies. We aimed to analyse the accuracy of ultrasound EFW overall, and by customised birth weight centile category (severe SGA, SGA, AGA, LGA). Also, the accuracy of estimating the centile category using calculated customised EFW centiles. We performed a retrospective study of pregnant women between 20-43 weeks gestation who underwent ultrasound within 7 days of delivery at a large tertiary maternity unit between January 2018 and December 2020. Stillbirths, major foetal anomalies and multiple pregnancies were excluded. The EFW and birth weight were compared, and an accurate estimate defined as ≤15% difference. The customised EFW and birth weight centiles were calculated and used to analyse the accuracy of category prediction. Of 2061 foetuses included, 92% (n = 1902) were born weighing within 15% of their EFW. Accuracy was not affected by maternal BMI, ethnicity, parity or gestation. 87% of SGA babies were within 15% of their EFW. Ultrasound sensitivity for SGA was 51% (95% CI: 46-55%). The specificity and positive predictive values were 97% (95% CI: 96-98%) and 87% (95% CI: 82-90%) respectively. The accuracy of Ultrasound EFW overall is good, however, is reduced in SGA babies whose EFW and birth weight centile categories tended to be overestimated. The high specificity for SGA supports monitoring with a lowered threshold to intervene in pregnancies identified by ultrasound as SGA.

Pharmaceutical services in public hospitals in Mexico: a cross-sectional study

To describe the provision of pharmaceutical services within Ministry of Health hospitals in Mexico and identify the main factors that affect their implementation. Between November 2018 and April 2019, we conducted telephone interviews with the heads of pharmacy departments of 413 state and federal Ministry of Health hospitals in Mexico. Responses were analyzed with descriptive and inferential statistics to determine the main factors influencing the implementation of pharmaceutical services within these public hospitals. Of the 413 hospitals, a total of 96 hospitals in 27 states reported the provision of at least one pharmaceutical service. The most frequently reported services were: patient education on the correct use of medications (23%), provision of information to other health professionals on the rational use of medications (21%), and participation in the hospital´s pharmacovigilance system (19%). The main factors associated with the implementation of HPS were the number of pharmacists (46%, n = 215, p=0.001) and the pharmaceutical- or health sciences-oriented education of the head of the pharmacy department of the hospital (46%, n = 215, P = 0.001). Hiring more pharmacists and ensuring the appropriate professional education of the head of the pharmacy department are key factors to expanding the implementation of pharmaceutical services in Mexico's public hospitals.

Factors affecting patient satisfaction with the quality of medical examination and treatment of public hospitals in Ho Chi Minh city

The research identified the factors affecting patient satisfaction with the quality of medical examination and treatment of public hospitals in Ho Chi Minh city. Data was collected from 369 patients who used medical examination and treatment services in public hospitals through a pre-designed questionnaire using the convenient sampling method. Descriptive statistical methods, reliability testing through Cronbach’s Alpha, exploratory factor analysis (EFA), and multiple linear regression were used in this study. Research results showed that six factors affecting patient satisfaction with the quality of medical examination and treatment at public hospitals in Ho Chi Minh city are arranged in order from the highest to lowest as follows: (1) respect and caring, (2) facilities, (3) costs of medical examination and treatment, (4) medical examination and treatment procedures, (5) effectiveness of medical examination and treatment, and (6) other support services. As a result, the research raised some solutions to help improve patient satisfaction with medical examination and treatment of public hospitals in Ho Chi Minh city and provided more evidence to assist the Ministry of Health to enhance the Patient Experience Survey Toolkit more appropriately in the current context.

Accounting, valuing and investing in health care: dealing with outdated accounting models

PurposeDespite major progress made in improving the health and well-being of millions of people, more efforts are needed for investment in 21st century health care. However, public hospital waiting lists continue to grow. At the same time, there has been increased investment in e-health and digital interventions to enhance population health and reduce hospital admissions. The purpose of this study is to highlight the accounting challenges associated with measuring, investing and accounting for value in this setting. The authors argue that this requires more nuanced performance metrics that effect a shift from a technical practice to one that embraces social and moral values.Design/methodology/approachThis research is based on field interviews held with clinicians, accountants and administrators in public hospitals throughout Australia and Europe. The field research and multidisciplinary narratives offer insights and issues relating to value and valuing and managing digital health investment decisions for the post-COVID-19 “value-based health-care” future of accounting in the hospital setting.FindingsThe authors find that the complex activity-based hospital funding models operate as a black box, with limited clinician understanding and hybridised accounting expertise for informed social, moral and ethical decision-making. While there is malleability of the health economics-derived activity-based hospital funding models, value contestation and conflict are evident in the operationalisation of these models in practice. Activity-based funding (ABF) mechanisms reward patient throughput volumes in hospitals but at the same time stymie investment in digital health. Although classified as strategic investments, there is a limit to strategic planning.Research limitations/implicationsAccounting in public hospitals has become increasingly visible and contested during the pandemic-driven health-care crisis. Further research is required to examine the hybridising accounting expertise as it is increasingly implicated in the incremental changes to ABF in the emergence of value-based health care and associated digital health investment strategies. Despite operationalising these health economic models in practice, accountants are currently being blamed for dysfunctional health-care decisions. Further education for practicing accountants is required to effect operational change. This includes education on the significant moral and ethical dilemmas that result from accounting for patient mix choices in public hospital service provision.Originality/valueThis research involved a multidisciplinary team from accounting, digital health, information systems, value-based health care and clinical expertise. Unique insights on the move to digital health care are provided. This study contributes to policy development and the limited value-based health-care literature in accounting.

Differences in Breast Cancer Costs by Cancer Stage and Biomarker Subtype in New Zealand.

BackgroundBreast cancer requires the greatest expenditure among all cancer types, and the costs vary by cancer stage and biomarker status.ObjectiveThis study aimed to examine the differences in public healthcare costs of breast cancer in New Zealand by stage and subtype.MethodThis study included patients diagnosed with invasive breast cancer between 1 July 2010 and 30 June 2018 and receiving services in public hospitals. These patients were identified from the National Breast Cancer Register and/or New Zealand Cancer Registry. Linking with the Pharmaceutical Collection, National Minimum Dataset, National Non-Admitted Patient Collection, and Mortality Collection, we estimated the median public healthcare costs of breast cancer by cancer stage and biomarker subtype.ResultsWe identified 22,948 eligible patients. The median costs of breast cancer increased with stage of disease, from $NZ26,930 for stage I disease to $NZ50,388 for stage IV disease. The median costs for human epidermal growth factor receptor 2-positive (HER2+) disease were three times those for HER2-negative (HER2−) disease: $NZ106,428 for HER2+ cancers compared with$NZ28,481 for oestrogen receptor-positive (ER+)/HER2− cancers and $NZ31,722 for triple negative disease. Over 55% of the costs for HER2+ breast cancers were targeted therapy costs. For HER2− cancers, surgery incurred the biggest cost, followed by radiotherapy.ConclusionsTreating patients with early-stage breast cancer is less costly than treating those with metastatic disease. The costs vary considerably between the subtypes. Patients with HER2+ cancer incurred three times the costs of those with HER2− cancers. These results provide baseline costing data for clinicians and policy makers when considering new targeted treatments.Supplementary InformationThe online version contains supplementary material available at 10.1007/s41669-022-00327-5.

Heterogeneity in gender dysphoria in a Brazilian sample awaiting gender-affirming surgery: a data-driven analysis

BackgroundPopulation heterogeneity and the lack of clinical and sociodemographic information in transgender individuals with gender dysphoria (GD) remains a challenge for specialized services in mental health and surgical procedures. It aimed to identify and describe profiles in a sample waiting for gender-affirming surgery.MethodsA sample of 100 outpatients with GD was assessed through a structured interview, Emotion Regulation Difficulty Scale (DERS), Ruminative Response Scale (RRS), Depression, Anxiety and Stress Scale (DASS-21) and Life Satisfaction scale (SWLS). Cluster analysis was used to identify different profile categories.ResultsTwo subgroups with different profiles were identified: with less clinical severity (LCS) and with high clinical severity (HCS) on emotional dysregulation, acute symptoms of depression, anxiety, stress and association with mental rumination. The HCS cluster had greater vulnerability in terms of psychiatric history, use of psychotropic drugs, HIV positive, child abuse and suicidal behavior.ConclusionDifferent profiles were found regarding the vulnerability to mental health in a sample of transgender people with GD who seek a public hospital service for the same clinical-surgical objective. Longitudinal studies are essential to monitor the impact of these contrasts and to target personalized therapeutic approaches in the prevention of psychiatric disorders.

Spatial Clusters of Chronic Childhood Conditions in the State of Paraíba, Brazil

Introduction:chronic conditions are complex health problems that require continuous and multidisciplinary care. When they affect children/adolescents, they require hospitalizations and periodic and long-term follow-up. Understanding the geographical distribution of these conditions will provide greater visibility to the problem and support the decision-making process. Objective: detect the spatial clusters of chronic health conditions affecting children and adolescents in the state of Paraíba, Brazil. Methods: ecological, retrospective, study employing secondary data from the Information System of Children and Adolescents with Chronic Disease from a reference hospital in the state of Paraíba, Brazil, covering the period from 2015 to 2017. The Spatial Incidence Ratio and the Spatial Scan statistic were used for the data analysis. Results: a concentration of spatial clusters was observed in the Mata Paraibana mesoregion, an area where the public hospital service is located, which functions as a reference in the recurrent hospitalizations of this population with chronic conditions. Conclusion: the detection of spatial clusters can help public managers to recognize the priority areas for the monitoring of chronic conditions in children and adolescents.

Penerapan Total Quality Management (TQM) dalam Meningkatkan Kualitas Pelayanan Rumah Sakit

TQM is one of the modern management concepts that strives to respond appropriately to any changes. TQM method is a method that is carried out in an effort to improve the quality, one of which is in the performance of hospitals in improving the quality of services in order to improve the quality of public hospital services, the management should try to carry out and synergize the hospital's integrated quality management based on the availability of facilities and services medical equipment supported by medical personnel who are quite reliable in their fields. Steps taken by the hospitali, among others, working with the government, opening up opportunities for relationships partnership for foreign investors to develop this hospital to be better in the future.&#x0D; Keywords: TQM, Service Quality.

Challenges perceived by nursing professionals in physician-centred organizations: An exploratory qualitative study.

To explore and analyse contextual challenges in nursing that have affected nurses' perceptions and role performance. Health system hierarchy and patient/family-centred care has led to a high demand for skilled nurses. However, patriarchal organizations create challenges for nursing clinicians in Pakistan and elsewhere. A qualitative exploratory research (phenomenology) design was used. Twenty-five participants identified through purposive sampling contributed to the study. The data analysis was conducted using NVivo 12 Plus. We generated six major themes. Reporting was accomplished according to the consolidated criteria for reporting qualitative research checklist. Gendered division of labour places nurses in a submissive position in clinical practice. Decreases in nurse-to-patient ratio and increase in patient-focused care adversely affect evidence-based practice. The gap between theory and practice in delivering quality care is increasing due to existing communication barriers among health-related professionals and an inadequate work environment. Comparatively inactive nursing leadership and directorate roles are not improving the social image of nursing, and are promoting role conflict and poor nursing self-concepts among nurses. In fact, cultural shock experienced by young nurses has produced inherent disorientation in their professionalism and fostered displays of horizontal violence towards them by senior nurses. These challenges are influencing nurses' decisions to remain in or to join nursing as a profession that is confronted by severe recruitment and retention shortages due to the social and cultural stigmatization of this female dominated profession. This study promotes the concept of evidence-based practice to deliver quality health services in public hospitals and to improve the social status of nursing in Pakistan. It provides influential evidence to policymakers who should urgently address nurses' workplace health and safety issues as a global right.

Anesthesia-related perioperative patient safety services in Indian public and private hospitals with or without teaching programs

Introduction: The World Health Organization is emphasizing global patient safety for more than a decade. However, very less is known about the patient safety environment in the perioperative settings in developing countries. The present secondary analysis aimed to compare the anesthesia-related patient safety measures and services in Indian public versus private and teaching versus nonteaching hospitals. Materials and Methods: The present study is a post hoc, subgroup analysis of a previously conducted cross-sectional, questionnaire-based, online survey during February–May 2019. Responses from the postgraduate trainee and consultant/qualified practitioners were included. Data related to the practice pattern and availability of standard, advanced monitoring, and equipment were then categorized based on the hospital funding source and availability of teaching program; compared using the Fisher's exact test, and P &lt; 0.05 was considered statistically significant. Results: Six hundred responses were included. The majority (60.7%) were from the private sector; 57.3% worked in teaching hospitals. Overall, anesthesia-related patient safety and equipment were deficient across the entire range of hospitals. However, there was no difference between matched public and private hospitals (P &gt; 0.05 for most), except the anonymous incident reporting, which was significantly higher in the corporate teaching hospitals (P &lt; 0.0001). Teaching hospitals had significantly better safety measures (P &lt; 0.0001 for most parameters) than nonteaching hospitals. Conclusion: Public sector hospitals in India are not having significantly different anesthesia services related to patient safety monitoring and equipment than private sector hospitals. However, the safety measures are relatively low in many aspects across all sectors, which need attention. The following core competencies are addressed in this article: Patient care, Systems-based practice.

Determinants Influencing Utilization of Health Care Services in Public Hospitals among Old People Living in Rural Areas: A Case of Kasulu District in Tanzania

Utilization of health care services continues to be one of the 21 st century’s global agenda especially among old people living in low- and middle-income countries due to their health vulnerability and accelerated increase number of the aging population. This paper aimed to assess determinants influencing utilization of health care services among old people living in rural areas of Tanzania. The study was conducted in Kasulu rural district covering three wards of Kimobwa, Nyenge and Nyachenda using descriptive cross-sectional study informed by two classical theories of disengagement and functionalist. Simple random and purposeful sampling procedures were used to obtain 323 participants which included 304 old people, six Social Workers, five Medical Doctors and eight Nurses. Collection of data was done by using questionnaire, in-depth interview, focus group discussion and observation. Thematic analysis was used to analysis qualitative data while quantitative data were analyzed descriptively using Statistical Package for the Social Sciences (SPSS) to obtain frequencies, percentages and statistical measures for triangulation purposes. Study findings revealed that social-economic determinants, availability of medicine and diagnostic instruments and distance to health facility has a strong influence on utilization of health care services among the old people in Tanzania. The study strongly recommends that, the government should provide financial support to poverty-stricken families caring for old people, introduce mobile clinic or home based care to old people and raise awareness on health education among old people.

Rates of Low-Value Service in Australian Public Hospitals and the Association With Patient Insurance Status

Low-value services have limited or no benefit to patients. Rates of low-value service in public hospitals may vary by patient insurance status, given that there may be different financial incentives for treatment of privately insured patients. To assess the variation in rates of 5 low-value services performed in Australian public hospitals according to patient funding status (ie, private or public). This retrospective cross-sectional study analyzed New South Wales public hospital data from January 2013 to June 2018. Patients included in the sample were over age 18 years and eligible to receive low-value services based on diagnoses and concomitant procedures. Data analysis was conducted from June to December 2020. Hospital-specific rates of low-value knee arthroscopic debridement, vertebroplasty for osteoporotic spinal fractures, hyperbaric oxygen therapy, oophorectomy with hysterectomy, and laparoscopic uterine nerve ablation for chronic pelvic pain were measured. For each measure, rates within each public hospital were compared by patient funding status descriptively and using multilevel models. A total of 219 862 inpatients were included in analysis from 58 public hospitals across the 5 measures. A total of 38 365 (22 904 [59.7%] women; 12 448 [32.4%] aged 71-80 years) were eligible for knee arthroscopic debridement for osteoarthritis; 2520 (1924 [76.3%] women; 662 [26.3%] aged 71-80 years), vertebroplasty for osteoporotic spinal fractures; 162 285 (82 046 [50.6%] women; 28 255 [17.4%] aged 61-70 years), hyperbaric oxygen therapy; 15 916 (7126 [44.8%] aged 41-50 years), oophorectomy with hysterectomy; and 776 (327 [42.1%] aged 18-30 years), uterine nerve ablation for chronic pelvic pain. Overall rates of low-value services varied considerably between measures, with the lowest rate for hyperbaric oxygen therapy (0.3 procedures per 1000 inpatients [47 of 158 220 eligible inpatients]) and the highest for vertebroplasty (30.8 procedures per 1000 eligible patients [77 of 2501 eligible inpatients]). There was significant variation in rates between hospitals, with a few outlying hospitals (ie, <10), particularly for knee arthroscopy (range from 1.8 to 21.0 per 1000 eligible patients) and vertebroplasty (range from 13.1 to 70.4 per 1000 eligible patients), with higher numerical rates of low-value services among patients with private insurance than for those without. However, there was no association overall between patient insurance status and low-value services. Overall differences in rates among those with and without private insurance by individual procedure type were not statistically significant. There was significant variation in rates of low-value services in public hospitals. While there was no overall association between private insurance and rate of low-value services, private insurance may be associated with low-value service rates in some hospitals. Further exploration of factors specific to local hospitals and practices are needed to reduce this unnecessary care.

Gender Trouble and Return of the Sexual in a Cisgender Research Collective Confronted With Trans∗ Femininity.

The author analyzes a research study of trans∗ women and their surgeons, conducted before and after vaginoplasty in a French public hospital service. The essay is an examination of countertransference in three research frameworks: (1) working with a research team; (2) taking part in a peer group, facilitated by a psychologist, a surgeon, and a secretary, bringing together women who had already undergone surgery and those awaiting it; and (3) research interviews with Lara, a 64-year-old trans∗ woman. The author emphasizes the importance of taking into account gender countertransference-that is, the disruptive effects of the encounter with trans∗ people and their desires, paying specific attention to what the encounter with trans∗ femininities has stirred or revealed in terms of the author's own relationship to the body and to cisgender femininity.

Effect of COVID-19 on the Number of CT-scans and MRI Services of Public Hospitals in Iran: An Interrupted Time Series Analysis.

In February 2020, the Ministry of Health and Medical Education in Iran announced the first case of COVID-19. The aim of this study was to investigate the impact of COVID-19 on the number of CT-Scans and MRI services in public hospitals in western Iran. We collected CT-scans and MRI services data from 18 public hospitals via Vice-Chancellor Office, Lorestan University of Medical Sciences from January 2017 to February 2021. Interrupted time series analysis (ITSA) was conducted to assess the impact of COVID-19 on CT-Scans and MRI services. More specifically, ITSA was conducted using ordinary least squares regression with the number of CT-Scans and MRI services per 1,000 registered persons per month as dependent variable. At the beginning of the observation period, the monthly rate of CT-Scans was constant (p for trend = 0.267) at 291.9 (from 95%CI 240.5 to 343.4) per 1,000 registered patients. The first case of COVID-19 coincided with an abrupt increase by 211.8 (from 95%CI 102.9 to 320.7) per 1,000 patients. Thereafter, the trend of CT-Scans did not change (p=0.576) compared to the pre-pandemic period. The rate of MRI services was 363.5 per 1,000 per registered patients per month (P = <0.0001) with a slightly decreasing trend (coefficient=-5; 95%CI, -6.9 to -3.1). The findings of this study showed that crises such as COVID-19 can affect the service delivery process. Health policymakers and decision makers should work to prevent potential reductions in health care during events such as COVID-19.

Awareness, expectation and satisfaction towards ward pharmacy services among patients in medical wards: a multi-centre study in Perak, Malaysia

BackgroundPatient’s awareness and satisfaction towards ward pharmacy services may influence perception towards effectiveness and safety of drugs, affecting medication adherence and clinical outcome. Nevertheless, studies on local ward pharmacy services were lacking. This study evaluated awareness, expectation and satisfaction of ward pharmacy services among patients in medical wards and determined their association with demographic characteristics.MethodsThis was a cross-sectional study using self-administered questionnaire conducted in medical wards of fourteen Perak state public hospitals from September to October 2020. In-patients aged ≥18 years old were included. The validated questionnaire had four domains. The student’s t-test, one-way analysis of variance (ANOVA) and multiple linear regression were was employed to evaluate the association between patients’ demographic characteristics with their awareness, expectation and satisfaction towards ward pharmacy services.Results467 patients agreed to participate (response rate = 83.8%) but only 441 were analysed. The mean age of the patients was 54.9 years. Majority was male (56.2%), Malay (77.3%), with secondary education (62.9%), rural resident (57.1%) and reported good medication adherence (61.6%). The mean awareness score was 49.6 out of 60. Patients were least aware about drug-drug interaction (3.85 ± 1.15) and proper storage of medications (3.98 ± 1.06). Elderly patients (β = − 2.82, P < 0.001) obtained lower awareness score. Patients with tertiary education (β = 3.87, P = 0.001), rural residents (β = 3.65, P < 0.001) and with good medication adherence (β = 2.55, P = 0.002) had higher awareness score. The mean expectation score was 44.0 out of 50. The patients had higher expectation to encounter a polite ward pharmacist (4.51 ± 0.56). Patients with tertiary education (β = 1.86, P = 0.024), rural residents (β = 1.79, P = 0.001) and with good medication adherence (β = 1.48, P = 0.006) demonstrated higher expectation. The mean satisfaction score was 43.6 out of 50. The patients had high satisfaction in language used (4.45 ± 0.57) and level of knowledge demonstrated (4.41 ± 0.62) by the ward pharmacists. Patients with tertiary education (β = 2.16, P = 0.009), rural residents (β = 1.82, P = 0.001) and with good medication adherence (β = 1.44, P = 0.009) demonstrated higher satisfaction, while elderly patients (β = − 1.17, P = 0.031) had lower satisfaction towards ward pharmacy services.ConclusionThere was a high level of awareness, expectation and satisfaction towards ward pharmacy services in public hospitals of Perak, Malaysia.